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Supporting people out of, and closing, Assessment and Treatment Units

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Assessment and Treatment Units are designed to offer short term crisis intervention. But data published in December 2015 says otherwise.

The 2015 Learning Disability Census report revealed that half of people in ATUs were already in that institution when analysis began in 2013.

Often, people are away from home and aren’t receiving the right support to promote independence and there is little opportunity to look into community based support options.

With the government’s Homes not Hospitals report promising to move half of the people out of ATUs and into a home, we’re highlighting a number of factors and solutions to consider to ensure that this is done correctly.

Challenging behaviour

Most behaviours that challenge can be prevented reduced or eliminated without the use of restrictive practices or restraint.

Personalised support and a focus on ensuring an individual has choice and control over their life are essential. They underpin best practice support for people with learning disabilities and autism.

Challenging behaviour is a form of communication, and a learned response to someone’s environment. Behaviour support strategies that are based on this understanding are twice as likely to be successful, compared to those that are not.

The solutions

  • Behaviour support specialists should carry out a functional behaviour assessment.
  • People who are at risk of admission should be placed on a regularly monitored register, and be provided with proactive and preventative support.

Mental Health Act

People with learning disabilities or autism can also have mental health issues. Often, mental health is overlooked because of their learning disability, or vice versa, meaning appropriate support isn’t provided.

The solutions

  • People with a learning disability or autism should be excluded from the Mental Health Act when there is no diagnosis of mental illness.
  • They should not be sectioned purely based on their behaviour, unless it is likely to cause significant harm to themselves or others.

Community based support

Supporting people with learning disabilities in their local community almost always produces better outcomes and is almost always less expensive. But, this requires a long-term plan and understanding that initial investment will lead to long term outcomes and savings.

The solutions

Treatment and support

  • People should not receive treatment and support in hospital, if the same treatment and support can be safely provided in a non-hospital setting or in the community.
  • Emphasis must be placed on preventing admissions and local authorities must ensure they commission providers with the necessary skills, e.g. providers who work extensively with Positive Behaviour Support.
  • People should be supported in services that have the capability to support people with behaviour that challenges, where there is involvement from community networks. Support workers must have access to psychologists, psychiatrists, behaviour analysts, nurses, speech and language therapists and social workers, where necessary.

Commissioners, procurement and providers

  • All organisations – providers, commissioners, CCGs, local authorities, the Department of Health and other bodies – must remain focused on ensuring all people with learning disabilities have the opportunity to move into personalised community services. This cannot be achieved by any one body in isolation.
  • The NHS and Commissioners must be mandated to follow the NICE best practice guidance to involve the individual and their family in decision making and procure services based on the suitability, rather than availability of, provision.
  • The commissioning framework should cover the NHS, CCGs and local authorities.
  • Local authority procurement must encourage service providers that deliver person-centred, evidence based, innovative support that concentrates on outcomes set by the individual.
  • There must be a reduction in the number of inpatient settings, through private sector closures.

We want to see at least 50% of all in-patient settings closing, leaving a small number of spaces in each local area as part of a local care pathway for short-term specialist support, in times of real crisis.

Local government must

  • Remove budgetary divisions, allowing resources to follow the individual and transfer with them when they move from one place to another.
  • Stimulate the specialist housing market, creating options for people to be able to live in an appropriate environment.
  • Be obliged to seek explicit and documented approval or consent from an individual to admit them to an inpatient setting.
  • Provide clear evidence that supports why an individual would be better off being admitted, rather than remaining in their own home and receiving treatment and support in the community.
  • Provide evidence that discussions have taken place with the individual and their family, and decisions have been documented, particularly where there is disagreement.
  • Ensure that a care plan is in place on admission, including a date for discharge and a clear goal for returning back to their home. This should be statutory.
  • Define clear and consistent thresholds for discharge.
  • Encourage individuals to request a transfer to a less restrictive setting, a setting closer to home or to be discharged.

National government must

  • Modify funding arrangements between health and social care so that there are incentives to move people from in-patient settings, and discourage further development of large, impersonal facilities.
  • Change the threshold of the proposed dowry arrangement – whereby the NHS funding automatically transfers to the local authority for people who have been in an institution for five years, to two years. The five year qualification may become an unintended disincentive for cash strapped local authorities.
  • Be more ambitious for people in ATUs and commit to developing local, community based services. This will require more funding and visionary thinking to acknowledge that this will save money in the long-term.

What we’re doing about it

We are working with local authorities across England to help people with learning disabilities find houses close to their families, in communities they choose.

We have the country’s largest in house team of Board Certified Behaviour Analysts. Together with highly trained staff, they can create a suitable service in the community for almost any individual.